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Help for question 3

How much is/are the plan's out-of-pocket limits?

Where to look

You will see:

  1. "Is there an out-of-pocket limit on my expenses?" and
  2. "What is not included in the out-of-pocket limit?"

under "Important Questions" on the Summary of Benefits and Coverage.

Only look at amounts for a single person (or individual) using a preferred (or in-network) provider.


Screenshot of example plan with arrows point to out-of-pocket questions (rows 3 and 4) of the Important Questions/Answer table

How to answer

If you see

Answer like this:
Only one out-of-pocket limit (no separate out-of-pocket limit for prescription drugs)

Fill out A.

Skip B1 and B2.

Go to Question 4.

An out-of-pocket limit and a separate out-of-pocket limit for prescription drug coverage

Skip A.

Fill out B1 with the medical out-of-pocket limit.

Fill out B2 with the prescription drug out-of-pocket limit.

Go to Question 4.